November 22, 2013

Hospital Declares War on Dietary Supplements

This hospital official actually seems to be bragging about the actions of the Children's Hospital of Philadelphia (CHOP). He says that to his knowledge, his hospital has become the first hospital in the country to remove dietary supplements from the formulary.

Does he have valid points? Yes, he does, but he is picking the worst examples to emphasize his points. Part of the reason this became necessary resulted from the hospital asking the incorrect questions in the first place. This may have been a large part of the reason the Joint Commission of Hospital Accreditation forced them into this action. Many times in the past, the hospital just asked whether they (the children) were receiving drugs, and Dr. Offit thinks that many parents didn't consider supplements to be drugs. This point is often the case.

Dr. Offit says, “Here is the way it works now: When you come to the hospital, we ask parents whether their children are receiving dietary supplements. So, for the first time, we are really finding out about the level of dietary supplementation, at least in the pediatric population in our hospital.”

I still think the hospital may be asking for incomplete information. Why aren't they asking about vitamins and minerals? Why are they not asking about herbal medications and supplements? Many parents still think that dietary supplements include only vitamins and minerals and not the rest.

Dr. Offit is correct that they are all drugs. They could have a pharmacologic and physiologic effect that is drug-like, so I think that is a very fair request on the hospital's part. On the other hand, the Food and Drug Administration doesn't regulate these products as drugs, so for the 54,000 dietary supplements on the market, there isn't a very good safety profile. Their efficacy claims are often not true.

In addition the labeling may not be accurate. Of concern also is that there are drug-drug interactions. For example, St. John's wort, which is metabolized through the liver, can affect immunosuppressant drugs that are given to transplant patients. There have been several reports of patients who rejected their transplants because the child or adult has been taking St. John's wort.

If the children are taking supplements, the hospital strongly discourages their use and gives them a pamphlet to explain why it is that these products are not what they claim to be. If the parents still want to use a dietary supplement and hospital does not consider it to be potentially harmful like St. John's wort, then the hospital will give them a waiver to sign that says that they are using dietary supplements against medical advice.

If you are interested, a more radical point of view may be read here. It certainly supports the doctor's bragging.

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